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Objective: The critical phase of perimenopausal period is marked by a reduction in estrogen levels, leading to various clinical issues (vasomotor and neurodegenerative symptoms, increased osteoporosis risk and cardiovascular risk). These complex clinical scenarios pose challenges to clinicians in providing the right support for diagnosis and treatment. A group of Italian cardiologists, endocrinologists, and gynecologists conducted a survey among expert colleagues to assess consensus on controversial issues and best practices for screening and treating peri‐ and postmenopausal women. Methods: The Delphi methodology was used to analyze responses from a qualitative expert panel comprising 25 cardiologists, 25 endocrinologists, and 25 gynecologists, selected nationwide. Two consecutive questionnaires were proposed between February and May 2023. Agreement among experts was assessed following the Delphi method as developed by the RAND Corporation. Results: The results of this Delphi Consensus have been shared by the leading scientific societies: Italian Society of Cardiology, Italian Society of Endocrinology, Italian Society of Gynecology and Obstetrics, and Italian Hospital Obstetricians Gynecologists Association. Conclusions: The experts highlighted comorbidities and hormone deprivation as crucial clinical problems to be evaluated in perimenopausal women, requiring investigation from cardiovascular and endocrinologic perspectives to assess cardiovascular risk, involving the use of BMI, standard blood samples, endocrine‐metabolic tests, and lifestyle assessment, particularly in women with higher cardiovascular and metabolic risks candidates for hormone replacement therapy (HRT). The experts also agreed on the benefits of HRT in improving lipid metabolism and reducing insulin resistance, thereby mitigating the metabolic risks associated with menopause. However, this therapy should be tailored considering individual women's comorbidities and thrombotic risk. Synopsis: The leading scientific societies agree that comorbidities and hormone deprivation are crucial clinical problems to be evaluated in peri‐ and postmenopause requiring specific cardiovascular and endocrinologic investigations. [ABSTRACT FROM AUTHOR]

Under conditions of intensifying strategic competition, great powers and less-than-great powers alike are reappraising their national-security strategies. Central to such reviews are assessments of power and strategic advantage – in an era of great-power competition, states need to know who is winning. This is the function of strategic net assessment, recently revived in the United Kingdom through the Secretary of State's Office for Net Assessment and Challenge. This paper sets out the conceptual challenges involved in making assessments of power, considers the main historical efforts to do so, and offers some practical guidance as to how strategic net assessment may be used to inform strategy. [ABSTRACT FROM AUTHOR]

Christian Dayé's new book, Experts, Social Scientists, and Techniques of Prognosis in Cold War America (2020), recounts the development of a set of techniques of expertise developed in the United States during the Cold War, and (ostensively) enabling policy makers to make decisions based on likely social, political, and military developments. The techniques and approaches were, in hindsight, shocking in their ambition, their arrogance, and even their sloppiness. The account helps us to understand how scientific findings and expert "opinion" came to be conflated in post-war America, and may be part of the explanation of why scientific authority no longer equates to public authority. [ABSTRACT FROM AUTHOR]

The key feature of a knowledge formation is that it finds a way to finance the production of knowledge. We are accustomed to thinking of universities as the standard knowledge formation of modern science, social science, and the humanities. But this was not true before the twentieth century and is decreasingly true in the twenty-first. The RAND Corporation, which evolved from its military origins, was a model alternative to this model. As Dayé shows, RAND produced ideas that would never have been developed in the university: two "prospection" techniques, Delphi and Political Gaming. It also created careers outside the university for brilliant misfits who savored intellectual delights and relevance that the university would have crushed. How they produced knowledge matters: it gives us some ideas about what is possible for future knowledge formations. [ABSTRACT FROM AUTHOR]

The following contribution is concerned with the relation of Dayé's work on the RAND Corporation during the Cold War and the field of ignorance studies. In doing so, I aim to emphasise the interconnection of three central themes that pervade Dayé's work: secrecy, ignorance, and power. In an era of Cold War insecurity, marked by strategic attempts by both sides to obscure their own capabilities, a largely secretive organization emerged as a reliable source of knowledge, helping to guide decision-making in uncertain times and to generate policy recommendations. This not only raises significant questions about the power of certain groups or individuals to define what counts as policy-guiding knowledge, it also points to a form of ignorance that is highly productive. It not only affords the creation of new knowledge practices, but it becomes a force in itself that mobilizes the creation of further ignorance. While these connections are implicit in Dayé's work, this study seeks to bring them to the forefront and to explore them in dialogue with classical sociological literature and in the context of seminal contributions to the field of ignorance studies. In order to do so, I will start with a brief elaboration on the secrecy that surrounded the work conducted at the RAND corporation, alongside a brief discussion of the notion of secrecy and elite power in the canon of classical literature in sociology, to then introduce the field of ignorance studies. From this angle, I will explore how a particular form of ignorance lies at the core of the workings at RAND and how ignorance studies might help to better understand the developing influence and rule of experts. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) can detect disease recurrence after focal therapy for prostate cancer, but there is no robust guidance regarding its use. The TARGET consensus recommendations provide guidance on the acquisition, interpretation, and reporting of MRI after focal therapy, as well as minimum standards for study reporting. Magnetic resonance imaging (MRI) can detect recurrences after focal therapy for prostate cancer but there is no robust guidance regarding its use. Our objective was to produce consensus recommendations on MRI acquisition, interpretation, and reporting after focal therapy. A systematic review was performed in July 2022 to develop consensus statements. A two-round consensus exercise was then performed, with a consensus meeting in January 2023, during which 329 statements were scored by 23 panellists from Europe and North America spanning urology, radiology, and pathology with experience across eight focal therapy modalities. Using RAND Corporation/University of California-Los Angeles methodology, the Transatlantic Recommendations for Prostate Gland Evaluation with MRI after Focal Therapy (TARGET) were based on consensus for statements scored with agreement or disagreement. In total, 73 studies were included in the review. All 20 studies (100%) reporting suspicious imaging features cited focal contrast enhancement as suspicious for cancer recurrence. Of 31 studies reporting MRI assessment criteria, the Prostate Imaging-Reporting and Data System (PI-RADS) score was the scheme used most often (20 studies; 65%), followed by a 5-point Likert score (six studies; 19%). For the consensus exercise, consensus for statements scored with agreement or disagreement increased from 227 of 295 statements (76.9%) in round one to 270 of 329 statements (82.1%) in round two. Key recommendations include performing routine MRI at 12 mo using a multiparametric protocol compliant with PI-RADS version 2.1 standards. PI-RADS category scores for assessing recurrence within the ablation zone should be avoided. An alternative 5-point scoring system is presented that includes a major dynamic contrast enhancement (DCE) sequence and joint minor diffusion-weighted imaging and T2-weighted sequences. For the DCE sequence, focal nodular strong early enhancement was the most suspicious imaging finding. A structured minimum reporting data set and minimum reporting standards for studies detailing MRI data after focal therapy are presented. The TARGET consensus recommendations may improve MRI acquisition, interpretation, and reporting after focal therapy for prostate cancer and provide minimum standards for study reporting. Magnetic resonance imaging (MRI) scans can detect recurrent of prostate cancer after focal treatments, but there is a lack of guidance on MRI use for this purpose. We report new expert recommendations that may improve practice. [ABSTRACT FROM AUTHOR]

Introduction: To assess patients' satisfaction with the dental care provided to them by the undergraduate students at Jordan University Hospital. In addition, to investigate whether the age or gender of patients had any correlation with the level of satisfaction. Materials and Methods: The Dental Satisfaction Questionnaire (DSQ) developed by the RAND Corporation was used to measure patient satisfaction. The questionnaire was translated to Arabic the native language of the country and it consisted of 14 questions, which measure the overall satisfaction and the subscales of access, convenience and availability, continuity of treatment and quality of dental care provided. Results: A total of 94 patients (58.5% female, 41.5% male) answered the DSQ, the Overall Dental Satisfaction Index (DSI) was found to be 86.2%, and there was no correlation between gender or age groups and the DSI (p <.05). All 14 questions scored above 4/5 except the question about whether the schools' building and dental units being modern and well equipped (3.7/5), and the general satisfaction question (3.2/5). Conclusions: Patients who were treated at the student clinics at the University of Jordan, School of Dentistry were found to be satisfied about both the quality of treatment and the dental environment, while reporting some negative aspects related mainly to the clinics building which they found to be very old and crowded. This study found no correlation between patients' satisfaction and the age or gender of the participants. [ABSTRACT FROM AUTHOR]

Applying the Delphi method, this study aims at characterizing the perceptions and needs of physicians, individuals with hemophilia, and their caregivers in relation to the management of routine visits during regular follow-ups. A single structured questionnaire, prepared by an advisory board, was administered to 139 participants, comprising hemophilia treaters, patients and caregivers, during the period from May to June 2023. Agreement (defined following the Delphi method as developed by RAND Corporation) was reached on several topics. The Principal Component Analysis methods identified the four most relevant areas where consensus was reached among the interviewees, underscoring the necessity for in-depth discussions during routine visits: (1) medical aspects related to symptoms, life-limitations, pain, etc.; (2) non-medical related aspects (ambitions, lifestyle, network, etc.); (3) logistical-organizational aspects (home–hospital distance, alternative modalities of communication); and (4) visit duration and telemedicine integration. The results of both the Delphi and Principal Component Analysis underline that the care of individuals with hemophilia extends beyond merely prescribing drugs or treatment regimens. Instead, it necessitates consideration of numerous variables from both therapeutic and non-therapeutic domains, all of which are deemed important for the holistic management of the individuals. As a result, these aspects are routinely discussed and addressed during visits. [ABSTRACT FROM AUTHOR]

Health-related quality of life (HRQoL) can be assessed through measures that can be generic or disease specific, encompass several independent scales, or employ holistic assessment (i.e., the derivation of composite scores). HRQoL measures may identify patients with differential risk profiles. However, the usefulness of generic and holistic HRQoL measures in identifying patients at higher risk of death is unclear. The aim of the present study was to undertake a scoping review of generic, holistic assessments of HRQoL as predictors of mortality in general non-patient populations and clinical sub-populations with specified conditions or risk factors in persons 18 years or older. Five databases were searched from 18 June to 29 June 2020 to identify peer-reviewed published articles. The searches were updated in August 2022. Reference lists of included and cited articles were also searched. Of 2552 articles screened, 110 met criteria for inclusion. Over one-third of studies were from North America. Most studies pertained to sub-populations with specified conditions and/or risk factors, almost a quarter for people with cardiovascular diseases. There were no studies pertaining to people with mental health conditions. Nearly three-quarters of the studies used a RAND Corporation QoL instrument, predominantly the SF-36, and nearly a quarter, a utility instrument, predominantly the EQ-5D. HRQoL was associated with mortality in 67 of 72 univariate analyses (92%) and 100 of 109 multivariate analyses (92%). HRQoL was found to be associated with mortality in the general population and clinical sub-populations with physical health conditions. Whether this relationship holds in people with mental health conditions is not known. HRQoL assessment may be useful for screening and/or monitoring purposes to understand how people perceive their health and well-being and as an indicator of mortality risk, encouraging better-quality and timely patient care to support and maximize what may be a patient's only modifiable outcome. [ABSTRACT FROM AUTHOR]

Four think tanks with close ties to the highest levels of government have shaped American foreign policy for decades. They are the Council on Foreign Relations, the RAND Corporation, the Bilderberg Group, and the Trilateral Commission. With direct ties to government officials who have engaged in various covert operations, these organizations provide a space within which advocates of global control can share ideas and develop new policies. Among the groups that have bravely questioned the consensus‐forming character of these think tanks are groups of people whose relatives died on 9/11. Because of their investigations into the government officials whose careers have blossomed as a result of 9/11, these ordinary citizens have become sharp critics of the expansionist ideology that was seemingly legitimized by 9/11. [ABSTRACT FROM AUTHOR]

In July 2017, the Department of Defense formalized its Global Health Engagement (GHE) policy and program with the publication of DOD Instruction (DODI) 2000.30, Global Health Engagement (GHE) Activities. As the sole service providing veterinary service support, a critical need existed for the Army Veterinary Corps (VC) to develop veterinary support of GHE capability to deliver Veterinary Corps Officers (VCO) prepared to support GHE missions across all Services. This article examines the underlying strategy for the deliberate development of a GHE support capability within the VC, beginning with a RAND Corporation study in 2008 to the culmination in 2022 of finalizing a VCO authorization at the last remaining Army Service Component Command aligned under a Geographic Combatant Command without one. Recommendations are offered for future capability development, particularly at the strategic echelon. [ABSTRACT FROM AUTHOR]

Purpose : Total hip arthroplasty (THA) and total knee arthroplasty (TKA) represent a significant portion of healthcare spending and are high-priority for quality improvement initiatives. This study aims to develop quality indicators (QIs) in the care of primary elective THA and TKA patients. These QIs serve a number of purposes including documentation of the quality of care, objective comparisons of institutions/providers, facilitating pay-for-performance initiatives, and supporting accountability, regulation, and accreditation. Methods: A guideline-based approach, initially described by Kötter et al., was utilized. Eight clinical practice guidelines (CPGs) were evaluated for candidate indicators (CIs). CIs with high-quality evidence and consensus statements were extracted. Eighteen additional CIs were included from previous work that evaluated quality improvement databases. Each CI and supporting evidence was submitted for independent review by an expert panel. The RAND Corporation-University of California, Los Angeles (RAND/UCLA) appropriateness methodology was utilized and items were rated based on validity, reliability, and feasibility of measurement. After two rounds of ratings and ranking, a final ranked list of QIs was obtained. Results: Fifty-six CIs were identified from the literature and CPGs or proposed by the expert panel. Two rounds of voting resulted in 12 total QIs that were deemed appropriate measures of high-quality care. The final 12 QIs were ranked by order of importance: use of peri-operative tranexamic acid, infusion of prophylactic antibiotics prior to inflation of tourniquet, appropriate post-operative venous thromboembolic prophylaxis, complication rate, rate of secondary procedure, readmission rate, early mobilization, average change of pre- to one year post-operative functional status, use of multimodal analgesia, use of neuraxial anesthesia, use of peri-articular injection in TKA, and use of pre-operative PO analgesia. Conclusion: This study is an expert opinion based on parameters observed in modern and high-quality academic settings. Twelve QIs are proposed to assess the quality of care in the peri-operative management of primary elective THA and TKA patients. [ABSTRACT FROM AUTHOR]

The article discusses Daniel Ellsberg, notable for his whistleblowing efforts through his release of the "Pentagon Papers" about American involvement in the Vietnam War to "The New York Times," other major American newspapers, and varied U.S. Senators. It focuses on a 1968 memorandum about the Tet Offensive written by Ellsberg while employed by the RAND corporation entitled “Impact of the VC Winter–Spring Offensive,” in which he comments upon the futility of the war and how it has become an inevitable failure for American and South Vietnamese forces.

Objectives: To generate evidence-based recommendations through formal consensus regarding the treatment of upper urinary tract infections during gestation. Materials and methods: Experts in microbiology, public health, internal medicine, infectious diseases, obstetrics, maternal fetal medicine and obstetric and gynecological infections participated in the consensus development group. The group also included professionals with training in clinical epidemiology, systematic data search, and representatives from the Health Secretariat and the Bogota Obstetrics and Gynecology Association. The participants disclosed their conflicts of interest. Starting with a clinical question, outcomes were graded and a systematic search was conducted in the Medline via PubMed, Embase, Lilacs, and Bireme databases. The search was expanded to include institutional repositories and antimicrobial resistance surveillance systems, with no language or date restrictions. The search was updated on October 1, 2022. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to assess the quality of the evidence and determine the strength of the recommendations. Finally, the RAND/UCLA (Research and Development/University of California Los Angeles) methodology was applied for the formal consensus. This document was reviewed by academic peers before publication. Results: The following are the consensus recommendations. Recommendation 1. The initial management of pregnant women with upper urinary tract infections (UTIs) should be approached in a hospital setting. Recommendation 2. The use of second generation cephalosporins is the suggested first option for empirical antimicrobial management in pregnant women with upper UTI in order to improve the rates of clinical and microbiological cure. Recommendation 3. Because of the risk-benefit balance, the use of aminoglycosides is suggested as a second option for empirical antimicrobial treatment in pregnant women presenting with upper UTIs in the second and third trimester. Recommendation 4. The use of third-generation cephalosporins is suggested as the third option for empirical antimicrobial treatment in pregnant women with upper UTIs given that the risk of inducing microbial resistance is high with this group of antibiotics. Recommendation 5. The use of carbapenems is suggested as a first option in pregnant women with upper UTIs and a history of infections caused by microorganisms with resistance to third or fourth-generation cephalosporins. Recommendation 6. The use of aminoglycosides or fourth-generation cephalosporins is suggested as a second option in pregnant women with upper UTIs and a history of infection caused by microorganisms with resistance to third-generation cephalosporins, taking risk-benefit into account. Recommendation 7. The use of piperacillin/tazobactam is suggested as a third option in pregnant women with upper UTIs and a history of infection caused by microorganisms with resistance to third or fourthgeneration cephalosporins. Recommendation 8. Getting a urine culture is recommended in pregnant women with upper UTIs before initiating empirical antimicrobial treatment. Recommendation 9. In pregnant women with upper UTIs, it is suggested to modify therapy in accordance with the results of the sensitivity test when the culture report shows resistance to the antimicrobial agent initiated empirically. Recommendation 10. In pregnant women hospitalized due to upper UTIs, it is suggested to switch to oral antimicrobial therapy after at least 48 hours of modulation of the systemic inflammatory response and the clinical signs of infection, and when tolerance to oral intake is adequate. Recommendation 11. In pregnant women with upper UTIs with no complications secondary to the primary infection, it is recommended to administer antibiotic therapy for a period of 7 to 10 days. Conclusions: It is expected that with this Colombian upper UTI consensus variability in clinical practice will be reduced. It is recommended that groups doing research in maternal fetal medicine assess the implementation and effectiveness of these recommendations. [ABSTRACT FROM AUTHOR]

Orally administered direct-acting antivirals (DAAs) have dramatically changed the possibility of curing HCV (hepatitis C virus) infection, with the two principal HCV regimens based on the combination of glecaprevir + pibrentasvir (GLE-PIB) and sofosbuvir + velpatasvir (SOF-VEL). A combination of drugs containing NS3/4A protease inhibitors, as well as the fact that almost all HCV patients can be treated at present, may expose patients to a higher rate of drug–drug interactions (DDIs). The hepatitis C treatment recommendations from the EASL (European Association for the Study of the Liver) state that, prior to starting treatment with a DAA, a detailed drug history should be taken; yet, the decision on managing the potential DDIs is not always clear. For this reason, a group of Italian cardiologists and hepatologists promoted a survey among colleagues to assess the controversial issues when treating patients with chronic hepatitis C taking concomitant cardiovascular drugs, aiming to reach a consensus on the best practice to apply when treating a patient with chronic hepatitis C who is taking concomitant drugs for cardiovascular diseases. Two consecutive questionnaires were proposed between June and July 2022 to a qualitative Expert Panel (EP) of 14 gastroenterologists, infectologists, hepatologists, and internists, with statistical analyses performed on 100% of the responses for both questionnaires. Agreement among experts was assessed following the Delphi method as developed by the RAND Corporation. The interviewed experts consider DDIs a critical clinical problem to be evaluated in HCV patients. Therefore, dose changes, drug substitution, and discontinuation of concomitant cardiovascular drugs should be discouraged, even if planned for a relatively short period. Since oral DAAs have different DDIs profiles, hepatologists should prefer the antiviral DAA combination presenting the lowest instance of potential interactions. [ABSTRACT FROM AUTHOR]

Objectives: To produce a best practice consensus guideline for the conduct of scrotal exploration for suspected testicular torsion using formal consensus methodology. Materials and Methods: A panel of 16 expert urologists, representing adult, paediatric, general and andrological urology used the RAND Corporation / University of California, Los Angeles (RAND/UCLA) Appropriateness Consensus Methodology to score a 184‐statement pre‐meeting questionnaire on the conduct of scrotal exploration for suspected testicular torsion. The collated responses were presented at a face‐to‐face online meeting and each item was rescored anonymously after a group discussion, facilitated by an independent chair with expertise in consensus methodology. Items were scored for agreement and consensus and the items scored with consensus were used to derive a set of best practice guidelines. Results: Statements scored with consensus increased from Round 1 (122/184, 66.3%) to Round 2 (149/200, 74.5%). Recommendations were generated in 10 categories: consent; assessment under anaesthetic; initial incision; intra‐operative decision making; fixation; medical photography; closure; operation note; logistics; and follow‐up after scrotal exploration. Our statements assume that the decision to operate has already been made. Key recommendations in the consent process included discussion of the possibility of orchidectomy and the possibility of subsequent infection of the affected testis or wound requiring antibiotic therapy. If after the examination under anaesthesia, the index of suspicion of testicular torsion is lower than previously thought, then the surgeon should still proceed to scrotal exploration as planned. A flow chart guiding decision making dependent on intra‐operative findings has been designed. If no torsion is present on exploration and bell clapper deformity is absent, the testis should not be fixed. When fixing a testis using sutures, a three‐ or four‐point method is acceptable and non‐absorbable sutures are preferred. Conclusions: We have produced consensus recommendations to inform best practice in the conduct of scrotal exploration for suspected testicular torsion. [ABSTRACT FROM AUTHOR]

Contemporary international turbulence has created a wide range of uncertainty and launched the concept of societal resilience, as a possibility to deal with the turbulences and tectonic changes of the international relations and global security. But how do we measure and how do we enforce the resilience stay remains an important issue for researchers. Therefore we tried to enter into the depth of the resilience studies and approaches and use what we have in hand as studies in sociology, history of conflicts and economic turbulences, geopolitical capability of the states and specially societal security. The paper emphasizes also the main points of a RAND Corporation study on the societal foundation of nations competitiveness as a mean to identify criteria and indicators for societal resilience. [ABSTRACT FROM AUTHOR]